All coaches and HPSS employed by national sporting organizations (NSOs) and national institute networks (NINs) in Australia’s high-performance sport system (the Australian Institute of Sport: AIS) were invited to participate in an anonymous online survey regarding their mental health and well-being. HPSS included high-performance directors, physiotherapists, nutritionists, medical doctors, sports psychologists, strength and conditioning coaches, athlete well-being and engagement advisors, and others involved in the daily training environment. No exclusion criteria were applied for survey participation other than the ability to read English.
A link to the online survey was provided to potential participants via text message or email (depending on each participant’s preferred AIS registered contact details). The survey was built by Orygen’s research database management team and hosted on a secure research management platform. The survey was open between March 16 and May 31, 2020. Participants completed the survey at a place and time of their choosing. The survey took approximately 20 min to complete and was enabled for completion on any electronic device (i.e., smartphone, computer or tablet).
All participants were provided with information about the purpose and nature of the survey prior to commencing, and informed consent was implied by participants choosing to click to ‘enter’ the survey. The survey concluded with participants being directed to a debriefing statement that included contact details for relevant mental health support services and the project investigators, should the participant wish to discuss their experience with the survey or any concerns regarding their responses. The research was approved by, and conducted in accordance with, the ethical standards of the University of Melbourne Human Ethics Research Committee (#13718) and the 1964 Helsinki Declaration.
The survey was developed in consultation with AIS staff and Paralympics Australia based on a previous project . Wherever possible, validated scales that were developed for, or used with, elite athletes and shown to be reliable in prior research were used in the survey, in order to enable comparisons.
Basic demographic details were collected, including participant age, gender, relationship status, sexual orientation and highest level of education. Participants were also asked about employment-related characteristics, including the number of years they had worked in high-performance sport, and their current employment status with a national sporting organization or institute and whether they had engaged in any voluntary or paid employment in the past month in addition to their sporting role. Sport-related characteristics included the type of sport(s) they coached or supported (e.g., individual or team-based), whether they were currently preparing athletes for upcoming competition, frequency of sport-related travel over the past 12 months, whether they had missed significant life events due to sport-related travel and concerns for safety while traveling for their sport in the 12 months prior to the survey. Participants were also asked if they had previously accessed treatment for a psychological issue or mental health problem.
Symptom Outcome Measures
Mental Health Symptoms and Probable Caseness The 28-item General Health Questionnaire (GHQ-28; ) was used to assess mental health symptoms in the past 4 weeks. The GHQ-28 includes a total score and four subscale scores, which assess somatic complaints (e.g., ‘been feeling run down and out of sorts’), anxiety and insomnia (e.g., ‘lost much sleep over worry’), social dysfunction (e.g., ‘felt on the whole you were doing things well’) and severe depression (e.g., ‘felt that life is entirely hopeless’). Items are scored 0 = not at all, 1 = no more than usual, 2 = more than usual and 3 = much more than usual, with GHQ-28 total scores ranging from 0 to 84.
The GHQ-28 can also be scored as a categorical measure, which can be used to indicate the proportion of participants meeting the threshold for ‘probable caseness’ (the reporting of psychological symptoms at a level that would usually warrant treatment from a health professional). To calculate caseness, binary coding is applied to the four response items (0 = not at all or no more than usual, 1 = more than usual or much more than usual) and the total score with this binary coding is calculated (range = 0–28). The cutoff score used was 5 or more indicating probable caseness, as per  and to allow comparisons with a comparable athlete sample .
Psychological Distress The Kessler-10 (K-10; ) was used to measure psychological distress. The K-10 requires respondents to rate the frequency at which they have experienced symptoms of psychological distress over the previous 4 weeks (e.g., ‘about how often did you feel that everything was an effort’). Items are scored 1 = none of the time, 2 = a little of the time, 3 = some of the time, 4 = most of the time, 5 = all of the time, where K-10 total scores range 10–50.
Risky Alcohol Consumption The Alcohol Use Disorder Identification Tool-Concise (AUDIT-C; ) was used as a brief 3-item measure of alcohol consumption that identified individuals at risk of risky alcohol consumption. Items enquire about frequency and quantity of alcohol consumption, where each item is scored 0–4 and total scores range from 0 to 12. To allow for comparisons with the previously published literature (e.g., ), we used a cutoff score equal to or above 4 for women and 5 for men to determine potentially risky alcohol consumption (also see footnote in Table 2 for the rate meeting risky alcohol consumption using the more stringent IOC recommended cutoffs ).
Sleep The Athlete Sleep Screening Questionnaire (ASSQ; ) was used to assess possible sleep disturbance. This measure includes five items that enquire about satisfaction with recent sleep quality, sleep duration, sleep onset latency, sleep maintenance and use of sleep medication. ASSQ total scores (range = 0–17) can be categorized into levels of sleep disturbance (5–7 = mild disturbance, 8–10 = moderate disturbance, 11–17 = severe disturbance) .
For each of the main mental health outcome measures, comparisons were made between coaches and HPSS versus published elite athlete data. Where possible, athlete data were obtained from a study with a comparable athlete sample, comprising athletes aged 17 years and older contracted with the AIS . Where comparison data with this sample were unavailable (i.e., for the AUDIT-C and ASSQ), data from studies with elite athlete samples that used the same cutoff scores as described above were used [15, 27, 28].
Quality of Life Past 4-week quality of life was assessed using a single item from the World Health Organisation  (‘Thinking about your life in the last 4 weeks, how would you rate your quality of life?’), rated on a five-point scale (1 = very poor, 2 = poor, 3 = neither good nor poor, 4 = good, 5 = very good).
Satisfaction with Life Satisfaction with life was assessed using the Satisfaction with Life Scale , which includes 5 items (e.g., ‘So far, I have gotten the important things I want in life’) rated on a 7-point scale (1 = strongly disagree, 2 = disagree, 3 = slightly disagree, 4 = neither agree or disagree, 5 = slightly agree, 6 = agree, 7 = strongly agree). Total scores range from 5–35.
Life balance was assessed using a single Y/N item (‘Are you satisfied with your life balance, e.g., managing your sport, work, social life, family, sleep, etc.?’).
Social support was assessed using six questions, which enquired about presence (Y/N) of support, main source of support, level of satisfaction with support (rated 1 = totally dissatisfied to 7 = completely satisfied), and experiences of social isolation (feeling of lacking companionship, feeling left out, feeling isolated; rated in terms of frequency 1 = hardly ever, 2 = some of the time, 3 = often). The social support items were assessed individually, rather than summed.
Adverse life events were assessed over the past year and lifetime. Thirteen items were included (see Additional file 1: Table S1), which included experiences of general adverse events (e.g., ‘A person close to me died’) and sport-specific events (e.g., ‘I felt under-valued or under-paid’; ‘I was harassed or abused on social media’), each rated 0 = no, never, 1 = yes, 2 = yes, past year.
Strategies for managing mental well-being was assessed by providing participants with a list of strategies commonly used to manage stress or mental well-being (e.g., ‘using relaxation techniques’; ‘talking with a friend/partner’), with participants indicating which of the strategies they used in their daily life with binary Y/N responses (see Additional file 1: Table S2).
Concern about COVID-19 At the time of the planned survey implementation, the COVID-19 pandemic was emerging, with attendant restrictions. A question was included in the survey to assess COVID-19 concern (Y/N), with affirmative responses asked to specify their level of concern about the pandemic (1 = a little concerned, 2 = somewhat concerned, 3 = greatly concerned) and specific concerns related to the pandemic via providing a list of potential concerns, as well as an open-ended response option for other concerns.
Categorical variables were summarized using frequencies and percentages, and continuous variables were summarized using mean and standard deviation. Group comparisons were made to examine possible differences according to demographic characteristics (e.g., gender, role) and for comparing coach and HPSS data to published data with elite athlete samples. Group comparisons for continuous outcome measures were made using independent samples t tests (measure of effect size = Cohen’s d), while comparisons for categorical outcome measures were made using chi-square (measure of effect size = Cramer’s V). All outcomes have been evaluated as statistically significant at the p ≤ 0.01 level, to reduce the risk of Type I error.
Separate regression models were developed for each major outcome: caseness (according to GHQ-28), psychological distress (K-10), alcohol consumption (AUDIT-C) and sleep (ASSQ). For caseness, which had a dichotomous outcome (i.e., meets caseness criteria vs does not meet criteria), logistic regression analysis was used. Continuous outcomes (K-10, AUDIT-C and ASSQ) were assessed for significant departures from normality using the Shapiro–Wilk test, and quantile median regression was used (where median scores were used instead of mean scores to account for departures from normality).
A two-stage analysis was performed for each model, where unadjusted associations were examined between the outcome measure and possible correlates, which included demographic variables (e.g., gender, age), sport-related characteristics (e.g., individual/team sport, frequency of sport-related travel), employment-related variables (e.g., number of years working in high-performance sport), number of adverse life events (past year and lifetime) and other possible psychosocial correlates (e.g., previous or current mental health treatment, satisfaction with life balance, satisfaction with social support). Additionally, the presence of concern about the COVID-19 pandemic (Y/N) and date of survey completion (pre- or post-announcement about the postponement of the Tokyo Olympics and Paralympics) were included as possible correlates in each regression model. In the second stage (following the identification of significant correlates), only significant correlates were entered into the adjusted model, therefore controlling for the effects of each salient variable from the unadjusted model. All analyses were conducted using IBM SPSS Statistics 25 and R Version 4.0.0.